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Swine Flu Reaches Three Continents With 'Less Severe' Illness
  By Tom Randall

May 1 (Bloomberg) -- Swine flu reached 12 countries on three continents, killing fewer people than past pandemics, world health officials said today.

Hong Kong confirmed a flu case today, the first in Asia, prompting the government to declare a public-health emergency. Laboratory tests have verified that more than 331 people in North America, Europe and New Zealand have the strain, according to the World Health Organization's Web site. Hundreds more cases are suspected in the U.S., Europe, Mexico and Australia.

The Geneva-based WHO raised its six-tier alert to 5 on April 29 and may move soon to the next and final level, declaring the world's first influenza pandemic since 1968. WHO urged countries to make final preparations against the disease, formally called H1N1. While initial cases have been similar to seasonal flu, the new strain may flash across the globe, preying on a world population with no natural immunity, said the U.S. Centers for Disease Control and Prevention.

Evidence suggests that "transmission is widespread, and that less severe illness is common," the Atlanta-based CDC said in a report today. In Mexico, where WHO said nine of 10 confirmed deaths from the virus occurred, "a large number of undetected cases of illness might exist in persons seeking care in primary-care settings or not seeking care at all."

Pigs, People, Birds

The new influenza strain, a conglomeration of genes from swine, bird and human viruses, poses the biggest threat of a large-scale flu pandemic since the emergence of the H5N1 strain in 2003 that has killed millions of birds and hundreds of people, said William Schaffner, an influenza expert at Vanderbilt University School of Medicine in Nashville, Tennessee, in an interview yesterday.

That disease killed more than half of the people who contracted it, though the virus didn't spread from person to person and only infected 421 people. The Spanish flu of 1918, another version of bird flu, killed as many as 50 million people in one of the most deadly disease outbreaks known.

"There are some genetic tests that have shown the virus we're dealing with right now does not have the factors that we think made the 1918 virus so bad," said Julie Gerberding, former head of the CDC, in an interview today on ABC News. "But we have to be careful not to over-rely on that information, because these flu viruses always evolve."

Spain Cases

Thousands of samples from sick patients are backlogged for testing, WHO said yesterday.

As the number of people sick with flu continued to rise, an outbreak in Spain may show the virus is establishing itself beyond Mexico and the U.S., approaching WHO's definition of a pandemic. The agency needs evidence of sustained human-to-human transmission outside North America to declare the outbreak a pandemic, officials said.

"What the public health community can and must do is provide the very best information," Michael Osterholm, director of the Center for Infectious Disease Research and Policy, at the University of Minnesota, in Minneapolis, said in a telephone interview. "We make general guideline recommendations, but it's all local leaders who decide."

WHO raised the alert to level 5 two days ago after swine flu took root in New York. It was the second elevation this week. The phase 5 warning is "a strong signal that a pandemic is imminent" with little time left for preparation, according to the Web site of WHO, an agency of the United Nations. It's based on the determination that the disease is established in communities in two countries in the same WHO region.

Schools Closed

In the U.S., at least 298 schools closed yesterday, leaving parents to find other arrangements for 172,000 students, according to the Education Department. The Centers for Disease Control and Prevention, a U.S. agency based in Atlanta, raised its flu count to 141 cases in 19 states, including a 22-month- old child who died April 27 at a Houston hospital.

A note sent to U.S. Department of Homeland Security employees and obtained by Bloomberg News said masks must be worn by all workers who come within six feet (1.8 meters) of people known to have or who are suspected of having the virus. The department's workers include customs and border officers and airport baggage screeners.

A Citigroup employee in New York and a World Bank employee in Maryland were preliminarily diagnosed with the flu. One of Barack Obama's aides who traveled to Mexico as part of last month's presidential trip, along with his family, showed symptoms.

World Bank

The World Bank yesterday gave $25.6 million to Mexico for antiviral drugs, medical supplies and equipment to test for swine flu. The payment is the first of $205 million the World Bank pledged on April 26 to help Mexico cope with the outbreak, according to the bank's news release.

Margaret Chan, WHO's director-general, said travel restrictions won't slow the flu. Countries should ready emergency plans, she said on April 29.

Batches of seed virus are being developed for potential vaccine production, according to WHO. Paris-based Sanofi-Aventis SA, Baxter International Inc. of Deerfield, Illinois, and GlaxoSmithKline Plc of London are talking with world health authorities about how to make a vaccine.

Production of shots against seasonal flu will be completed before pandemic flu vaccine production begins, if that decision is made, said Richard Besser, acting head of the CDC.

Drugs Deployed

The CDC deployed antiviral drugs from the U.S. stockpile to 9 of 11 states with confirmed cases, Besser said. Shipments to the two other states should be finished by May 3. The CDC is adding more communications staff and equipment to field 4,000 calls, 2,000 e-mails and up to 8 million visits to its Web site a day, he said.

The U.S. will spend $251 million to buy 13 million courses of antiviral treatments to replenish its stockpile, said Health and Human Services Secretary Kathleen Sebelius.

Jose Cordova, the health minister in Mexico, where the toll is highest, said yesterday the number of H1N1 flu cases confirmed by laboratory tests climbed to 312 from 260, and the death toll remained at 12. Deaths from the virus will probably rise, he said.

A "worrisome sign from Mexico was the relatively young healthy adults" succumbing to the virus, Anne Schuchat, interim deputy director of the CDC science and public health program, said yesterday in Congress. She said the average age of those in the U.S. confirmed to have the flu is 22.

Spain Question

WHO's statistics, which lag behind those reported by national and local agencies, showed confirmed cases in the U.S., Mexico, Canada, Austria, Germany, the Netherlands, Switzerland, Israel, Spain, the U.K. and New Zealand. Only the U.S. and Mexico have confirmed deaths, according to WHO.

Among the 13 cases in Spain, at least one patient hadn't traveled to Mexico, said Dick Thompson, a spokesman for WHO. One case "confirmed to us that there's some community transmission beginning," he said. "The virus is becoming established in another area. It's this new single case that is especially worrying."

A case in Germany also isn't connected to Mexico, WHO said.

Texas, California

President Obama asked Congress this week for $1.5 billion to battle an outbreak, and said parents should plan for school closings. Texas Governor Rick Perry declared a disaster, a "pre-emptive" measure to facilitate emergency preparations and seek federal reimbursement. California Governor Arnold Schwarzenegger declared a state of emergency.

New Zealand today said the number of people suspected as having the flu is 116, and said it has four laboratory-confirmed cases and 12 probable cases. In total, there are 388 people in isolation and receiving medication, said the health ministry in New Zealand, the only Asia-Pacific nation with WHO-confirmed cases.

South Korea said it found two more probable flu cases, taking its total to three. Japan said test results for a 17- year-old male who visited Canada may be available today to determine if he's the nation's first swine-flu case. China began checking the body temperatures of travelers from the U.S.

Seasonal Strains

The three main seasonal flu strains -- H3N2, H1N1 and type- B -- cause 250,000 to 500,000 deaths a year globally, according to WHO. The new flu's symptoms are similar, including fever and coughing, nausea and vomiting, according to the CDC. It appears to be causing more diarrhea than seasonal flu, WHO said.

The U.S. can expect more hospitalizations and deaths, Sebelius said. Authorities advised hand-washing, hygiene and staying home if sick as the most effective ways to control the outbreak.

A Marine is recovering after being confirmed as having the virus, and another 37 Marines are being "watched and tested" at a base with 15,000 personnel in 29 Palms, California, Marine Corps Commandant General James Conway said at the Pentagon.

As many as 400,000 pigs are being slaughtered in Egypt as a precaution.

The flu infections in people aren't related to exposure to pigs, and properly prepared pork is safe to eat, said Keiji Fukuda, WHO assistant director-general for health security and environment.

To contact the reporters on this story: Tom Randall in New York at

Last Updated: May 1, 2009 12:06 EDT

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